Sharie Darensbourg

Chronic Foot Pain Causes

Do You Understand Heel Discomfort?

Overview

Heel Discomfort

Heel pain is pain in the heel area that can vary in severity and location. It is most common in adults. The heel is the first bone to contact the ground when walking and takes the full force of impact and the resulting shock of bearing weight during motion.

Causes

There are several causes of heel pain. By far the most common cause in adults is a condition commonly known as plantar fasciitis. Other names occasionally used for the same condition are heel spurs, and policeman?s heel. Plantar means bottom of the foot, and fascia is the fibrous tissues that helps tether the heel bone (calcaneus) to the heads of the metatarsal bones found at the base of your toes The meaning of ?itis? is inflammation. However, inflammation does not have a large part to play in the pathology, it is more degenerative (wear & tear) so the preferred title is plantar fasciosis or plantar aponeurotic fasciosis. For simplicity sake, we will refer to this common cause of heel pain as plantar fasciitis in this manual.

Symptoms

Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation maybe aggravated by shoes that lack appropriate support and by the chronic irritation that sometimes accompanies an athletic lifestyle. Achilles Tendinopathy, Pain and inflammation of the tendon at the back of the heel that connects the calf muscle to the foot. Sever?s, Often found in children between the ages of 8 - 13 years and is an inflammation of the calcaneal epiphyseal plate (growth plate) in the back of the heel. Bursitis, An inflamed bursa is a small irritated sack of fluid at the back of the heel. Other types of heel pain include soft tissue growths, Haglunds deformity (bone enlargement at the back of the heel), bruises or stress fractures and possible nerve entrapment.

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

Orthotics, by treating the cause of the problem, lead to the cure bette than 90% of the time. A small number of patients have waited so long that the plantar fascia has become thickened and filled with scar tissue and are not helped by ?conventional? means. Those are the patients that have, traditionally, required surgical treatment in which the plantar fascia is cut off the heel bone. Luckily, most surgery has been replaced by a relatively new mode of treatment, ESWT or Extracorporeal Shockwave Therapy. ESWT involves the application of multiple shockwaves to the diseased tendon or ligament and has an approximately 85 to 90% success rate. Keep in mind we are talking about this success rate in patients who are ?tough cases,? that is, already had the conventional treatment. The ESWT machines look like miniature renal lithtripsors (kidney stone crushers). There are virtually no side effects to ESWT other than the price as only about 30% of insurance companies are paying for it. They realize that it is less costly and safer than surgery but also know that many more people who would avoid surgery would have no problem getting ESWT so the volume of services would go up. You don?t have to live with painful heels.

Surgical Treatment

If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.

pain in back of heel

Prevention

Heel Pain

Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.
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